Highland Hospital — Pricing

292 procedures published in this hospital's Machine-Readable File (MRF) — 289 with a comparable price, 3 with per-payer negotiated rates only. Prices shown are pre-insurance; actual cost depends on your plan, Medicare/Medicaid coverage, or cash-pay discounts.

Procedures published 292
Lowest published price $14,965
Average published price $76,394
Highest published price $488,449

Gross charges are the hospital's listed price — almost no one pays this amount. Your actual cost depends on your insurance plan. Use the cash price (when shown) as a guide for what uninsured patients are charged, and contact the hospital or your insurer for a personalized cost estimate.

Showing all 292 procedures

Published charges

Showing all 289 procedures with a comparable published price (gross, cash, or insurance-negotiated median), sorted highest to lowest. Green = this hospital prices below the median; amber = above.

Across 43 procedures, this hospital's negotiated rates average ≈68% of what Medicare pays.

DRG Description Published price Cash price vs. CA median vs. National median vs Medicare
884 ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY $488,449 $244,225 $35,352 +1282% $25,208 +1838% ≈67% of Medicare
004 TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES $477,045 $238,523 $248,521 +92% $245,241 +95% —
005 TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE,EXTREME $477,045 — $189,963 +151% $159,181 +200% —
070 OTHER CEREBROVASCULAR DISORDERS WITH MCC $267,273 $133,636 $36,506 +632% $30,814 +767% ≈68% of Medicare
853 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC $242,227 $121,113 $94,937 +155% $87,018 +178% ≈58% of Medicare
441 DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC $231,349 $115,675 $39,057 +492% $32,399 +614% —
974 HIV WITH MAJOR RELATED CONDITION WITH MCC $228,793 $114,397 $57,493 +298% $46,402 +393% —
207 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS $227,396 $113,698 $116,058 +96% $116,058 +96% —
371 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC $224,674 $112,337 $36,661 +513% $31,758 +607% —
870 SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS $218,315 $109,158 $124,290 +76% $138,008 +58% ≈53% of Medicare
617 AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC $212,238 $106,119 $42,881 +395% $42,881 +395% —
171 PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK,MAJOR $211,629 — $211,629 — $82,174 +158% —
545 CONNECTIVE TISSUE DISORDERS WITH MCC $206,461 $103,230 $49,765 +315% $39,657 +421% —
061 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC $189,645 $94,822 $52,735 +260% $57,963 +227% —
919 COMPLICATIONS OF TREATMENT WITH MCC $186,416 $93,208 $37,933 +391% $29,031 +542% —
274 PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC $180,186 $90,093 $65,573 +175% $65,573 +175% —
130 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS,MAJOR $178,168 — $23,289 +665% $23,289 +665% —
760 OTHER MENTAL HEALTH CONDITIONS AND DISORDERS,MAJOR $172,663 — $21,880 +689% $18,282 +844% —
887 OTHER MENTAL DISORDER DIAGNOSES $172,663 $86,332 $26,404 +554% $20,602 +738% —
907 OTHER O.R. PROCEDURES FOR INJURIES WITH MCC $171,951 $85,976 $77,817 +121% $71,701 +140% —
350 INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC $169,083 $84,542 $51,487 +228% $46,591 +263% —
231 MAJOR LARGE BOWEL PROCEDURES,MAJOR $167,047 — $155,631 +7% $146,474 +14% —
230 MAJOR SMALL BOWEL PROCEDURES,MINOR $166,138 — $93,713 +77% $88,720 +87% —
331 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC $166,138 $83,069 $36,651 +353% $44,117 +277% —
336 PERITONEAL ADHESIOLYSIS WITH CC $162,211 $81,105 $46,332 +250% $49,470 +228% —
435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC $159,742 $79,871 $37,950 +321% $37,950 +321% —
882 NEUROSES EXCEPT DEPRESSIVE $151,547 $75,773 $21,356 +610% $15,680 +867% —
388 GASTROINTESTINAL OBSTRUCTION WITH MCC $150,726 $75,363 $31,982 +371% $28,780 +424% —
673 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC $145,313 $72,656 $81,281 +79% $72,945 +99% —
181 RESPIRATORY NEOPLASMS WITH CC $140,198 $70,099 $24,648 +469% $22,431 +525% —
721 POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS,EXTREME $138,995 — $138,995 — $51,822 +168% —
418 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC $137,691 $68,846 $36,816 +274% $42,119 +227% —
892 HIV WITH MAJOR HIV RELATED CONDITION,MAJOR $135,098 — $135,098 — $39,896 +239% —
466 MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE,MAJOR $127,240 — $96,507 +32% $96,222 +32% —
354 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC $125,588 $62,794 $37,764 +233% $43,266 +190% —
322 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC $125,002 $62,501 $40,163 +211% $54,772 +128% —
305 AMPUTATION OF LOWER LIMB EXCEPT TOES,MODERATE $124,708 — $16,665 +648% $17,144 +627% —
284 DISORDERS OF GALLBLADDER AND BILIARY TRACT,MINOR $123,698 — $16,450 +652% $13,282 +831% —
710 INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE,MODERATE $123,692 — $33,330 +271% $23,814 +419% —
314 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC $120,026 $60,013 $43,483 +176% $38,357 +213% ≈73% of Medicare
243 PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC $116,402 $58,201 $50,011 +133% $50,011 +133% —
854 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC $114,272 $57,136 $44,357 +158% $43,524 +163% —
174 PERCUTANEOUS CARDIAC INTERVENTION WITH AMI,MINOR $113,568 — $113,568 — $74,377 +53% —
063 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC $113,497 $56,748 $30,887 +267% $35,542 +219% —
175 PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE $112,941 $56,471 $30,959 +265% $29,757 +280% —
674 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC $112,511 $56,255 $49,631 +127% $49,631 +127% —
064 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC $110,667 $55,333 $40,719 +172% $35,714 +210% ≈58% of Medicare
462 NEPHRITIS AND NEPHROSIS,EXTREME $110,119 — $58,975 +87% $56,758 +94% —
871 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC $110,000 $55,000 $40,263 +173% $35,237 +212% ≈69% of Medicare
205 OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC $109,544 $54,772 $39,013 +181% $32,204 +240% —
192 CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS,MINOR $107,629 — $14,368 +649% $14,368 +649% —
384 UNCOMPLICATED PEPTIC ULCER WITHOUT MCC $106,161 $53,081 $19,305 +450% $19,305 +450% —
698 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC $106,141 $53,070 $35,532 +199% $30,058 +253% ≈73% of Medicare
982 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC $105,524 $52,762 $51,985 +103% $51,985 +103% —
375 DIGESTIVE MALIGNANCY WITH CC $103,297 $51,648 $27,277 +279% $27,219 +279% —
062 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC $103,182 $51,591 $37,214 +177% $48,680 +112% —
152 OTITIS MEDIA AND URI WITH MCC $100,045 $50,023 $25,192 +297% $19,795 +405% —
330 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC $99,647 $49,823 $50,562 +97% $58,832 +69% —
208 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS $98,688 $49,344 $52,405 +88% $52,405 +88% ≈64% of Medicare
629 OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC $98,231 $49,115 $48,634 +102% $45,059 +118% —
421 MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS,MODERATE $97,996 — $36,354 +170% $36,333 +170% —
775 ALCOHOL ABUSE AND DEPENDENCE,MINOR $97,597 — $3,032 +3119% $3,242 +2911% —
241 PEPTIC ULCER AND GASTRITIS,MODERATE $96,972 — $33,519 +189% $24,229 +300% —
896 ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC $96,434 $48,217 $37,213 +159% $30,275 +219% —
100 SEIZURES WITH MCC $96,084 $48,042 $40,653 +136% $35,194 +173% ≈70% of Medicare
419 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC $95,942 $47,971 $29,250 +228% $34,887 +175% —
446 URETHRAL AND TRANSURETHRAL PROCEDURES,MINOR $95,626 — $17,700 +440% $17,700 +440% —
689 KIDNEY AND URINARY TRACT INFECTIONS WITH MCC $95,149 $47,575 $25,980 +266% $22,982 +314% ≈69% of Medicare
372 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC $94,694 $47,347 $22,850 +314% $22,850 +314% —
091 OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC $94,532 $47,266 $37,921 +149% $36,375 +160% —
377 GASTROINTESTINAL HEMORRHAGE WITH MCC $92,187 $46,093 $37,842 +144% $37,842 +144% ≈69% of Medicare
177 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC $91,464 $45,732 $34,448 +166% $31,840 +187% ≈64% of Medicare
552 MEDICAL BACK PROBLEMS WITHOUT MCC $90,149 $45,074 $21,396 +321% $21,213 +325% ≈68% of Medicare
364 OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES,MINOR $89,579 — $89,579 — $46,852 +91% —
167 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC $89,559 $44,779 $40,563 +121% $40,563 +121% —
811 RED BLOOD CELL DISORDERS WITH MCC $89,279 $44,639 $30,922 +189% $27,934 +220% —
374 DIGESTIVE MALIGNANCY WITH MCC $87,487 $43,744 $42,775 +105% $38,885 +125% —
263 CHOLECYSTECTOMY,MINOR $87,327 — $55,918 +56% $44,938 +94% —
922 OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC $87,319 $43,659 $35,675 +145% $29,409 +197% —
287 CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC $84,075 $42,037 $24,191 +248% $31,190 +170% —
542 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC $82,740 $41,370 $38,631 +114% $35,114 +136% —
438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC $82,614 $41,307 $35,243 +134% $32,502 +154% —
193 SIMPLE PNEUMONIA AND PLEURISY WITH MCC $82,095 $41,048 $29,252 +181% $26,158 +214% ≈72% of Medicare
123 NEUROLOGICAL EYE DISORDERS $81,910 $40,955 $17,831 +359% $17,831 +359% —
040 SPINAL DISORDERS AND INJURIES,MODERATE $81,195 — $74,257 +9% $74,257 +9% —
072 OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC $80,877 $40,438 $16,654 +386% $16,654 +386% —
253 OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,MODERATE $80,410 — $53,746 +50% $53,746 +50% —
303 ATHEROSCLEROSIS WITHOUT MCC $80,190 $40,095 $14,927 +437% $14,927 +437% —
140 CHRONIC OBSTRUCTIVE PULMONARY DISEASE,MINOR $80,100 — $84,217 −5% $60,098 +33% —
113 INFECTIONS OF UPPER RESPIRATORY TRACT,MODERATE $80,019 — $48,760 +64% $35,642 +125% —
065 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS $79,865 $39,932 $22,575 +254% $23,469 +240% ≈57% of Medicare
385 OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS,MAJOR $79,569 — $34,588 +130% $26,020 +206% —
918 POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC $79,186 $39,593 $19,638 +303% $15,045 +426% —
233 APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS,MINOR $79,118 — $144,569 −45% $138,868 −43% —
045 CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION,MINOR $77,914 — $77,914 — $77,914 +0% —
184 MAJOR CHEST TRAUMA WITH CC $77,706 $38,853 $23,711 +228% $20,842 +273% ≈68% of Medicare
191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC $77,011 $38,506 $19,072 +304% $18,278 +321% —
605 TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC $75,997 $37,999 $20,506 +271% $19,287 +294% —
756 ACUTE ANXIETY AND STRESS SYNDROMES,MINOR $75,816 — $21,201 +258% $15,589 +386% —
145 ACUTE BRONCHITIS AND RELATED SYMPTOMS,MAJOR $75,448 — $26,302 +187% $20,842 +262% —
393 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC $75,431 $37,716 $35,113 +115% $32,689 +131% ≈72% of Medicare
439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC $74,922 $37,461 $19,096 +292% $19,096 +292% —
050 NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS,EXTREME $74,624 — $74,624 — $97,974 −24% —
097 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC $74,624 $37,312 $67,560 +10% $57,855 +29% —
872 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC $74,017 $37,008 $22,888 +223% $22,781 +225% ≈68% of Medicare
133 RESPIRATORY FAILURE,MINOR $73,984 — $23,289 +218% $23,289 +218% —
291 HEART FAILURE AND SHOCK WITH MCC $73,585 $36,793 $28,966 +154% $25,020 +194% ≈66% of Medicare
817 INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE,EXTREME $73,187 — $56,278 +30% $36,097 +103% —
894 ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA $72,271 $36,135 $13,855 +422% $12,013 +502% —
534 FRACTURES OF FEMUR WITHOUT MCC $72,170 $36,085 $18,070 +299% $17,195 +320% —
773 OPIOID ABUSE AND DEPENDENCE,MAJOR $71,835 — $71,835 — $87,384 −18% —
897 ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC $71,835 $35,918 $19,584 +267% $16,049 +348% ≈65% of Medicare
602 CELLULITIS WITH MCC $71,746 $35,873 $31,970 +124% $29,347 +144% ≈71% of Medicare
234 APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS,MINOR $71,688 — $102,573 −30% $102,573 −30% —
660 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC $71,663 $35,832 $29,747 +141% $30,358 +136% —
386 INFLAMMATORY BOWEL DISEASE WITH CC $71,197 $35,598 $22,033 +223% $20,968 +240% —
101 SEIZURES WITHOUT MCC $70,112 $35,056 $20,461 +243% $19,954 +251% ≈68% of Medicare
700 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC $69,882 $34,941 $15,411 +353% $13,303 +425% —
682 RENAL FAILURE WITH MCC $69,845 $34,923 $32,520 +115% $27,854 +151% ≈73% of Medicare
056 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC $68,683 $34,341 $49,382 +39% $39,409 +74% —
153 OTITIS MEDIA AND URI WITHOUT MCC $67,900 $33,950 $15,799 +330% $14,473 +369% —
292 HEART FAILURE AND SHOCK WITH CC $67,628 $33,814 $19,118 +254% $16,212 +317% —
580 OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC $66,778 $33,389 $39,360 +70% $36,242 +84% —
199 HYPERTENSION,MINOR $66,422 — $36,952 +80% $31,491 +111% —
073 CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC $66,195 $33,097 $33,256 +99% $28,252 +134% —
540 OSTEOMYELITIS WITH CC $66,182 $33,091 $28,728 +130% $23,494 +182% —
637 DIABETES WITH MCC $65,396 $32,698 $31,753 +106% $28,819 +127% —
092 OTHER DISORDERS OF NERVOUS SYSTEM WITH CC $65,218 $32,609 $23,503 +177% $24,136 +170% —
813 COAGULATION DISORDERS $64,753 $32,376 $33,296 +94% $30,128 +115% —
663 OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS,MINOR $64,260 — $33,907 +90% $29,924 +115% —
607 MINOR SKIN DISORDERS WITHOUT MCC $63,471 $31,736 $19,185 +231% $15,284 +315% —
378 GASTROINTESTINAL HEMORRHAGE WITH CC $63,280 $31,640 $21,886 +189% $21,886 +189% ≈69% of Medicare
391 ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC $62,519 $31,259 $28,515 +119% $27,244 +129% ≈68% of Medicare
501 MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,MINOR $62,505 — $39,619 +58% $37,975 +65% —
728 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC $62,505 $31,253 $18,139 +245% $16,837 +271% —
557 TENDONITIS, MYOSITIS AND BURSITIS WITH MCC $62,370 $31,185 $33,325 +87% $28,646 +118% —
917 POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC $62,170 $31,085 $34,839 +78% $28,134 +121% ≈70% of Medicare
758 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC $61,798 $30,899 $22,628 +173% $19,091 +224% —
047 TRANSIENT ISCHEMIA,MINOR $61,555 — $61,555 — $56,677 +9% —
434 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC $61,288 $30,644 $15,462 +296% $12,405 +394% —
420 DIABETES,MINOR $60,747 — $70,175 −13% $50,919 +19% —
914 TRAUMATIC INJURY WITHOUT MCC $60,734 $30,367 $20,344 +199% $15,593 +289% —
057 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC $60,167 $30,083 $29,623 +103% $25,426 +137% —
283 OTHER DISORDERS OF THE LIVER,MINOR $59,659 — $40,150 +49% $35,014 +70% —
206 OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC $58,269 $29,134 $20,108 +190% $17,731 +229% —
185 MAJOR CHEST TRAUMA WITHOUT CC/MCC $57,677 $28,839 $17,265 +234% $15,858 +264% —
052 ALTERATION IN CONSCIOUSNESS,MINOR $57,640 — $41,111 +40% $30,940 +86% —
640 MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC $56,807 $28,403 $29,481 +93% $24,480 +132% ≈71% of Medicare
531 FEMALE REPRODUCTIVE SYSTEM INFECTIONS,MODERATE $56,539 — $56,539 — $37,084 +52% —
138 BRONCHIOLITIS AND RSV PNEUMONIA,MAJOR $56,219 — $19,492 +188% $17,383 +223% —
149 DYSEQUILIBRIUM $55,146 $27,573 $16,594 +232% $17,203 +221% —
197 PERIPHERAL AND OTHER VASCULAR DISORDERS,MAJOR $54,552 — $21,977 +148% $20,106 +171% —
639 DIABETES WITHOUT CC/MCC $54,523 $27,262 $13,910 +292% $13,910 +292% —
399 APPENDIX PROCEDURES WITHOUT CC/MCC $54,467 $27,234 $24,948 +118% $30,314 +80% —
176 PULMONARY EMBOLISM WITHOUT MCC $54,302 $27,151 $18,081 +200% $18,081 +200% —
683 RENAL FAILURE WITH CC $54,240 $27,120 $19,733 +175% $18,620 +191% ≈65% of Medicare
445 DISORDERS OF THE BILIARY TRACT WITH CC $53,994 $26,997 $24,075 +124% $21,806 +148% —
309 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC $53,761 $26,880 $16,412 +228% $16,865 +219% —
093 OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC $53,734 $26,867 $17,522 +207% $17,522 +207% —
048 PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS,MINOR $53,709 — $53,709 — $31,203 +72% —
427 THYROID DISORDERS,MODERATE $53,506 — $132,794 −60% $121,728 −56% —
644 ENDOCRINE DISORDERS WITH CC $53,506 $26,753 $22,941 +133% $22,941 +133% —
188 PLEURAL EFFUSION WITHOUT CC/MCC $53,255 $26,628 $16,299 +227% $14,110 +277% —
948 SIGNS AND SYMPTOMS WITHOUT MCC $53,197 $26,599 $17,638 +202% $17,727 +200% —
641 MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC $53,025 $26,512 $17,347 +206% $16,745 +217% ≈67% of Medicare
189 PULMONARY EDEMA AND RESPIRATORY FAILURE $52,672 $26,336 $27,470 +92% $25,704 +105% ≈69% of Medicare
816 TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES,MODERATE $52,545 — $14,638 +259% $13,485 +290% —
893 HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,MODERATE $52,469 — $52,469 — $49,110 +7% —
539 OSTEOMYELITIS WITH MCC $52,175 $26,088 $41,277 +26% $33,746 +55% —
204 SYNCOPE AND COLLAPSE,MINOR $52,019 — $18,004 +189% $16,866 +208% —
536 FRACTURES OF HIP AND PELVIS WITHOUT MCC $51,875 $25,938 $18,002 +188% $18,002 +188% —
074 CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC $51,761 $25,880 $23,141 +124% $23,141 +124% —
975 HIV WITH MAJOR RELATED CONDITION WITH CC $51,024 $25,512 $31,166 +64% $25,010 +104% —
690 KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC $50,871 $25,435 $17,817 +186% $17,466 +191% ≈71% of Medicare
921 COMPLICATIONS OF TREATMENT WITHOUT CC/MCC $50,604 $25,302 $15,267 +231% $14,012 +261% —
134 PULMONARY EMBOLISM,MINOR $50,279 — $23,289 +116% $23,289 +116% —
194 HEART FAILURE,MINOR $50,097 — $18,204 +175% $18,204 +175% —
155 OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC $49,766 $24,883 $20,725 +140% $16,642 +199% —
862 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC $49,054 $24,527 $38,187 +28% $30,394 +61% —
890 HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS,MODERATE $48,975 — $48,975 — $57,033 −14% —
440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC $48,930 $24,465 $13,683 +258% $15,070 +225% —
390 GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC $48,506 $24,253 $13,318 +264% $13,318 +264% —
068 PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC $48,073 $24,036 $19,569 +146% $19,569 +146% —
687 KIDNEY AND URINARY TRACT NEOPLASMS WITH CC $48,055 $24,028 $23,369 +106% $18,478 +160% —
178 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC $47,402 $23,701 $22,024 +115% $22,024 +115% —
530 FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,MODERATE $47,318 — $47,318 +0% $47,318 +0% —
699 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC $47,300 $23,650 $22,641 +109% $20,732 +128% —
282 DISORDERS OF PANCREAS EXCEPT MALIGNANCY,MINOR $47,269 — $16,097 +194% $18,623 +154% —
603 CELLULITIS WITHOUT MCC $47,227 $23,613 $19,553 +142% $18,530 +155% ≈71% of Medicare
392 ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC $47,154 $23,577 $17,322 +172% $17,322 +172% ≈67% of Medicare
252 MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE,MINOR $46,483 — $68,508 −32% $68,508 −32% ≈13% of Medicare
300 PERIPHERAL VASCULAR DISORDERS WITH CC $45,797 $22,899 $23,767 +93% $19,579 +134% —
544 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC $45,287 $22,643 $16,776 +170% $16,776 +170% —
379 GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC $45,034 $22,517 $14,134 +219% $14,134 +219% —
863 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC $45,033 $22,516 $22,197 +103% $20,007 +125% —
347 OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES,MODERATE $44,915 — $50,614 −11% $40,548 +11% —
069 TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC $44,888 $22,444 $17,762 +153% $20,278 +121% —
249 OTHER GASTROENTERITIS, NAUSEA AND VOMITING,MINOR $44,874 — $23,643 +90% $20,610 +118% —
248 MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS,MODERATE $44,784 — $23,643 +89% $34,146 +31% —
394 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC $43,969 $21,985 $20,896 +110% $18,918 +132% ≈60% of Medicare
125 OTHER DISORDERS OF THE EYE WITHOUT MCC $43,793 $21,896 $18,330 +139% $15,876 +176% —
812 POISONING OF MEDICINAL AGENTS,MODERATE $43,528 — $20,488 +112% $20,488 +112% ≈43% of Medicare
190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC $42,853 $21,427 $24,930 +72% $24,190 +77% ≈68% of Medicare
054 MIGRAINE AND OTHER HEADACHES,MINOR $42,783 — $32,473 +32% $29,484 +45% —
638 DIABETES WITH CC $42,512 $21,256 $20,361 +109% $18,821 +126% ≈71% of Medicare
281 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC $42,393 $21,197 $20,463 +107% $20,463 +107% ≈67% of Medicare
304 HYPERTENSION WITH MCC $41,921 $20,960 $26,080 +61% $24,185 +73% —
179 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC $41,636 $20,818 $17,087 +144% $14,444 +188% —
831 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC $41,415 $20,708 $25,552 +62% $18,133 +128% —
389 GASTROINTESTINAL OBSTRUCTION WITH CC $41,130 $20,565 $17,795 +131% $17,388 +137% —
246 GASTROINTESTINAL VASCULAR INSUFFICIENCY,MODERATE $40,940 — $23,643 +73% $33,983 +20% —
604 TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC $40,886 $20,443 $32,248 +27% $28,140 +45% —
144 RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES,MINOR $40,784 — $38,998 +5% $29,558 +38% —
251 ABDOMINAL PAIN,MAJOR $40,656 — $34,689 +17% $41,380 −2% —
315 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC $40,572 $20,286 $21,363 +90% $20,777 +95% —
139 OTHER PNEUMONIA,MINOR $40,051 — $30,480 +31% $21,014 +91% —
623 SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC $39,967 $19,984 $42,463 −6% $33,165 +21% —
312 SYNCOPE AND COLLAPSE $39,852 $19,926 $19,342 +106% $19,342 +106% ≈67% of Medicare
554 BONE DISEASES AND ARTHROPATHIES WITHOUT MCC $39,247 $19,624 $18,528 +112% $18,253 +115% —
537 SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC $39,044 $19,522 $20,401 +91% $16,352 +139% —
426 NON-HYPOVOLEMIC SODIUM DISORDERS,MODERATE $39,039 — $189,537 −79% $142,326 −73% —
157 DENTAL AND ORAL DISEASES WITH MCC $38,556 $19,278 $34,802 +11% $27,457 +40% —
444 DISORDERS OF THE BILIARY TRACT WITH MCC $38,238 $19,119 $35,591 +7% $31,128 +23% —
103 HEADACHES WITHOUT MCC $37,764 $18,882 $18,874 +100% $20,111 +88% —
920 COMPLICATIONS OF TREATMENT WITH CC $37,526 $18,763 $22,552 +66% $21,181 +77% —
244 DIVERTICULITIS AND DIVERTICULOSIS,MINOR $37,017 — $40,063 −8% $40,063 −8% —
833 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC $36,828 $18,414 $11,539 +219% $9,076 +306% —
066 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC $36,754 $18,377 $15,280 +141% $19,483 +89% —
308 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC $36,387 $18,193 $26,770 +36% $26,488 +37% —
380 SKIN ULCERS,MODERATE $36,292 — $39,627 −8% $36,641 −1% —
561 AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC $35,805 $17,902 $18,150 +97% $18,150 +97% —
774 COCAINE ABUSE AND DEPENDENCE,MINOR $35,719 — $3,032 +1078% $3,032 +1078% —
558 TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC $35,674 $17,837 $19,176 +86% $17,367 +105% —
424 OTHER ENDOCRINE DISORDERS,MINOR $35,110 — $49,209 −29% $39,253 −11% —
247 INTESTINAL OBSTRUCTION,MINOR $35,032 — $23,643 +48% $21,663 +62% —
947 SIGNS AND SYMPTOMS WITH MCC $34,705 $17,352 $28,553 +22% $25,474 +36% —
425 OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS,MODERATE $34,121 — $34,316 −1% $25,484 +34% —
111 VERTIGO AND OTHER LABYRINTH DISORDERS,MINOR $33,952 — $33,952 +0% $32,376 +5% —
344 OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS,MINOR $33,701 — $56,127 −40% $44,839 −25% —
280 ALCOHOLIC LIVER DISEASE,MINOR $33,645 — $34,867 −4% $28,967 +16% ≈28% of Medicare
563 FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC $33,364 $16,682 $19,842 +68% $18,803 +77% ≈68% of Medicare
137 MAJOR RESPIRATORY INFECTIONS AND INFLAMMATIONS,MODERATE $33,289 — $31,048 +7% $24,348 +37% —
143 OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES,MODERATE $32,609 — $68,616 −52% $52,908 −38% —
201 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS,MINOR $32,530 — $15,031 +116% $13,081 +149% —
310 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC $32,530 $16,265 $13,384 +143% $13,384 +143% —
043 MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES,MINOR $32,341 — $32,341 — $46,703 −31% —
202 BRONCHITIS AND ASTHMA WITH CC/MCC $31,878 $15,939 $21,460 +49% $17,273 +85% —
469 ACUTE KIDNEY INJURY,MINOR $31,766 — $65,788 −52% $65,254 −51% —
770 DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE,MINOR $31,226 — $23,887 +31% $17,943 +74% —
180 RESPIRATORY NEOPLASMS WITH MCC $30,669 $15,335 $36,658 −16% $36,658 −16% —
313 CHEST PAIN $30,562 $15,281 $15,837 +93% $15,962 +91% —
195 SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC $30,219 $15,110 $13,824 +119% $13,824 +119% —
058 OTHER DISORDERS OF NERVOUS SYSTEM,MINOR $30,199 — $38,308 −21% $29,609 +2% —
550 SEPTIC ARTHRITIS WITHOUT CC/MCC $30,082 $15,041 $19,138 +57% $16,156 +86% —
351 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES,MINOR $29,942 — $33,399 −10% $33,792 −11% —
042 DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS,MODERATE $29,838 — $39,018 −24% $39,018 −24% —
203 CHEST PAIN,MINOR $29,069 — $15,464 +88% $12,279 +137% —
387 INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC $28,824 $14,412 $14,880 +94% $14,880 +94% —
596 MAJOR SKIN DISORDERS WITHOUT MCC $28,186 $14,093 $24,000 +17% $17,226 +64% —
293 HEART FAILURE AND SHOCK WITHOUT CC/MCC $28,083 $14,041 $13,326 +111% $11,955 +135% —
463 KIDNEY AND URINARY TRACT INFECTIONS,MINOR $27,886 — $101,662 −73% $78,582 −65% —
465 URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION,MINOR $27,708 — $38,541 −28% $32,839 −16% —
383 CELLULITIS AND OTHER SKIN INFECTIONS,MINOR $27,681 — $28,065 −1% $26,634 +4% —
720 SEPTICEMIA AND DISSEMINATED INFECTIONS,MINOR $27,219 — $27,219 — $47,150 −42% —
443 DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC $27,211 $13,606 $15,600 +74% $15,600 +74% —
053 SEIZURE,MINOR $27,058 — $20,455 +32% $20,309 +33% —
141 ASTHMA,MINOR $26,417 — $47,696 −45% $34,900 −24% —
566 ANTEPARTUM WITHOUT O.R. PROCEDURE,MINOR $26,164 — $16,607 +58% $14,337 +82% —
662 SICKLE CELL ANEMIA CRISIS,MINOR $26,017 — $63,279 −59% $54,483 −52% —
198 ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS,MINOR $25,829 — $15,549 +66% $13,654 +89% —
311 ANGINA PECTORIS $25,829 $12,914 $15,502 +67% $15,165 +70% —
844 PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT,MINOR $25,122 — $26,533 −5% $20,421 +23% —
935 NON-EXTENSIVE BURNS $25,122 $12,561 $43,274 −42% $29,458 −15% —
254 OTHER DIGESTIVE SYSTEM DIAGNOSES,MINOR $25,016 — $38,836 −36% $38,836 −36% —
395 OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC $25,016 $12,508 $14,128 +77% $14,128 +77% —
694 URINARY STONES WITHOUT MCC $24,630 $12,315 $17,347 +42% $16,531 +49% —
432 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC $23,938 $11,969 $40,213 −40% $36,933 −35% —
245 INFLAMMATORY BOWEL DISEASE,MINOR $23,314 — $95,281 −76% $72,076 −68% —
082 EYE INFECTIONS AND OTHER EYE DISORDERS,MODERATE $22,985 — $46,288 −50% $36,237 −37% —
832 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC $22,847 $11,423 $16,592 +38% $12,895 +77% —
442 DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC $22,742 $11,371 $21,449 +6% $21,449 +6% —
299 PERIPHERAL VASCULAR DISORDERS WITH MCC $21,457 $10,728 $34,467 −38% $25,731 −17% —
342 FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK,MINOR $19,591 — $23,289 −16% $19,454 +1% —
556 SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC $18,979 $9,489 $18,126 +5% $17,715 +7% —
142 INTERSTITIAL AND ALVEOLAR LUNG DISEASES,MAJOR $17,090 — $34,906 −51% $34,906 −51% —
196 INTERSTITIAL LUNG DISEASE WITH MCC $17,090 $8,545 $38,951 −56% $30,766 −44% —
071 OTHER CEREBROVASCULAR DISORDERS WITH CC $16,970 $8,485 $23,396 −27% $23,396 −27% —
551 MEDICAL BACK PROBLEMS WITH MCC $15,907 $7,954 $35,961 −56% $31,086 −49% —
861 SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS,MINOR $14,965 — $14,965 — $27,175 −45% —

Procedures with negotiated rates only

These 3 procedures have published per-payer insurance agreements but no single comparable dollar amount in the MRF — typically because the agreement is expressed as a percentage of charge, a fee schedule reference, or a contract algorithm. The number of payers indicates how many insurance plans have a negotiated rate on file.

DRG Description Insurance rate range Payers
560 AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC — 14 plans
885 PSYCHOSES — 14 plans
750 SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS,EXTREME — 11 plans
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